Myomectomy

What is myomectomy?

Myomectomy is a surgical procedure designed to remove fibroids (also known as leiomyomas or myomas) from the uterus while preserving the uterus itself. Fibroids are benign (non-cancerous) growths that develop from the muscle tissue of the uterine wall and are influenced by hormonal factors, particularly oestrogen and progesterone. Although they can occur without causing symptoms, fibroids may lead to heavy menstrual bleeding, pelvic pain or pressure, abdominal swelling, urinary frequency, constipation, or fertility challenges.

Unlike hysterectomy, which involves the complete removal of the uterus, myomectomy specifically targets fibroid removal, which makes it a preferred choice for women who wish to retain their uterus for future pregnancy or personal reasons. The procedure aims to alleviate symptoms, improve quality of life, and, in some cases, enhance reproductive outcomes.

Myomectomy can be performed using different surgical approaches, including open (abdominal), minimally invasive laparoscopic or robotic-assisted techniques, and hysteroscopic methods for fibroids within the uterine cavity. The choice of technique depends on factors such as the size, number, and location of the fibroids, as well as the patient’s symptoms, reproductive goals, and overall health.

When is myomectomy needed?

Myomectomy is recommended when fibroids cause symptoms that affect a woman’s health, comfort, or fertility, and when preserving the uterus is desired. The decision to proceed with surgery is based on the size, number, and location of fibroids, as well as the severity of symptoms and the patient’s reproductive plans.

• Heavy or prolonged menstrual bleeding — persistent heavy bleeding that leads to anaemia or interferes with daily life is a common reason for considering myomectomy, especially when medical treatments have not been effective.

• Pelvic pain or pressure — large or multiple fibroids can cause a sensation of heaviness, pressure, or pain in the pelvic region, which may worsen during menstruation or physical activity.

• Bladder and bowel symptoms — fibroids pressing against the bladder may cause frequent urination or difficulty emptying the bladder, while those pressing on the rectum may lead to constipation.

• Fertility concerns — fibroids that distort the uterine cavity or block the fallopian tubes can interfere with conception or increase the risk of miscarriage. Myomectomy may improve fertility outcomes in such cases.

• Rapid fibroid growth — although fibroids are benign, a sudden increase in size may warrant removal to rule out rare conditions such as sarcoma and to alleviate potential symptoms.

• Preparation for assisted reproduction — in some women undergoing treatments such as in vitro fertilisation (IVF), removal of fibroids that could affect implantation or pregnancy outcomes may be advised.

What are the different types of myomectomy?

The choice of myomectomy technique depends on the size, number, and position of the fibroids, as well as the patient’s symptoms, recovery expectations, and fertility plans. Each approach has specific advantages and considerations, and the surgeon will recommend the most appropriate method after a thorough evaluation.

• Abdominal myomectomy — this traditional surgical approach involves making an incision in the lower abdomen to access the uterus directly. It is most suitable for removing larger fibroids or when multiple fibroids need to be taken out at the same time. The open approach allows the surgeon full visibility and control, which is beneficial in complex cases.

• Laparoscopic myomectomy — this minimally invasive method uses small incisions and a laparoscope (a thin tube with a camera) to remove fibroids. It generally results in less postoperative discomfort, shorter hospital stays, quicker recovery, and smaller scars compared to open surgery. Laparoscopic myomectomy is best suited for smaller or fewer fibroids.

• Hysteroscopic myomectomy — performed through the cervix using a hysteroscope, this approach is ideal for removing fibroids located within the uterine cavity (submucosal fibroids). As it requires no abdominal incisions, recovery is typically faster, and patients can often resume normal activities within a short time.

How is myomectomy performed?

Myomectomy is carried out under either general or regional anaesthesia, ensuring that the patient remains comfortable and pain-free during the operation. The exact steps depend on the surgical approach chosen, but the overall process follows a structured sequence.

• Preparation — before surgery, the patient undergoes preoperative assessments, which may include imaging studies such as ultrasound or MRI to determine the size, number, and location of fibroids. Blood tests are also performed to check overall health and identify any conditions that need to be managed before the procedure.

• Anaesthesia administration — anaesthesia is given to ensure the patient’s comfort and safety. The type used will depend on the surgical technique and the patient’s medical profile.

• Incision — the surgeon makes an incision that corresponds to the chosen myomectomy method. This could be a small keyhole incision for laparoscopic surgery, an abdominal incision for open surgery, or no external incision in the case of hysteroscopic myomectomy.

• Removal of fibroids — the fibroids are carefully separated from the surrounding uterine tissue. The surgeon works precisely to preserve as much healthy uterine muscle as possible, which is particularly important for women who wish to maintain fertility.

• Closure — once the fibroids are removed, the uterus is repaired with dissolvable stitches. Any external incisions are then closed, and dressings are applied to protect the surgical site.

What are the risks of myomectomy?

Although myomectomy is generally considered safe, it carries potential risks, as with any surgical procedure. These can be divided into short-term surgical risks and longer-term considerations. Careful preoperative planning and experienced surgical technique help minimise these risks.

Short-term surgical risks

These are complications that may arise during or shortly after the procedure, most of which can be managed effectively with prompt medical attention.

• Anaesthesia complications — rare reactions to anaesthesia, including allergic responses or breathing difficulties.

• Infection — may occur at the incision site or within the uterus, sometimes requiring antibiotic treatment.

• Bleeding — significant blood loss can happen during fibroid removal, with some cases needing a blood transfusion.

• Damage to surrounding organs — small risk of injury to the bladder, bowel, or nearby blood vessels.

• Uterine rupture — a rare but serious complication that may occur in future pregnancies, especially if the uterine wall was deeply incised.

Long-term risks

These complications may develop weeks, months, or even years after surgery, and can affect reproductive health or cause other symptoms.

• Recurrence of fibroids — fibroids may regrow or new ones may develop after surgery.

• Infertility — scar tissue inside the uterus (intrauterine adhesions) can occasionally affect future pregnancy outcomes.

• Adhesions — scar tissue outside the uterus may form, potentially leading to pelvic discomfort or, in rare cases, bowel obstruction.

How can myomectomy improve quality of life?

Myomectomy can bring considerable relief for women whose daily lives are affected by fibroid-related symptoms. By addressing the underlying cause, the surgery not only eases physical discomfort but may also enhance emotional well-being and reproductive health.

• Reduction in menstrual symptoms — many women experience a marked decrease in heavy menstrual bleeding and period-related pain following surgery, which can help prevent anaemia and improve energy levels.

• Improved physical comfort — removing fibroids can relieve pelvic pressure, bloating, and discomfort, making it easier to engage in everyday activities and exercise without pain.

• Enhanced fertility — in cases where fibroids are contributing to infertility or pregnancy loss, myomectomy can improve the chances of successful conception and a healthy pregnancy.

• Psychological benefits — the relief from chronic pain, discomfort, and the anxiety associated with heavy or unpredictable bleeding often leads to a more positive mood, reduced stress, and improved mental well-being.

What is the recovery process after myomectomy?

Recovery after myomectomy varies depending on the surgical approach used, the size and number of fibroids removed, and the patient’s overall health. Understanding the expected healing timeline and postoperative care can help patients prepare and support a smooth recovery.

• Hospital stay — for abdominal myomectomy, most patients remain in hospital for two to three days, while laparoscopic and hysteroscopic procedures may require only a day or even same-day discharge.

• Initial recovery period — discomfort, mild abdominal pain, or cramping is common in the first few days and can be managed with prescribed pain relief. Swelling and fatigue may also occur. Patients are usually advised to avoid strenuous activity during this stage.

• Return to normal activities — full recovery from abdominal myomectomy typically takes four to six weeks, whereas laparoscopic or hysteroscopic approaches may allow a return to regular routines within two to three weeks. Driving, heavy lifting, and intense exercise should be avoided until cleared by the surgeon.

• Follow-up care — a postoperative appointment is scheduled to monitor healing and discuss any pathology results. The surgeon will also provide personalised advice on when it is safe to resume sexual activity and, if applicable, when to plan for pregnancy.

• Long-term healing — internal healing of the uterus continues beyond the initial recovery phase. Patients planning a pregnancy are often advised to wait several months to allow the uterine wall to regain strength.

Summary 

Myomectomy is a surgical procedure that removes fibroids from the uterus while preserving the uterus itself, making it an important option for women who wish to retain fertility or avoid hysterectomy. It is recommended when fibroids cause significant symptoms such as heavy menstrual bleeding, pelvic pain or pressure, bladder or bowel disturbances, or fertility challenges. Depending on the size, number, and location of the fibroids, myomectomy can be performed through abdominal, laparoscopic, or hysteroscopic techniques. The procedure involves careful preoperative planning, safe removal of fibroids, and precise uterine repair. 

While generally safe, it carries potential short-term risks such as bleeding, infection, and injury to nearby organs, as well as longer-term risks including recurrence of fibroids and adhesion formation. Successful surgery can significantly improve quality of life, reducing menstrual symptoms, enhancing physical comfort, improving fertility, and offering psychological benefits. Recovery times vary by surgical approach, with minimally invasive methods allowing a quicker return to normal activities. 

If you are experiencing fibroid-related symptoms and want to explore treatment options, schedule a consultation with Holistic Gynaecology & Fertility to discuss whether myomectomy is right for you.